The ever present question… “can I talk about this in here?” If you’ve been to therapy, you’ve probably thought this exact question in session at some point or another. And the answer is simple, yes, you can. So why do some therapists put up boundaries around what you can, should or need to talk about in the therapy room? Let’s talk about it.
Speciality
Not every therapist is going to be specialized in every niche aspect of mental health. There’s a reason there are eating disorder specialists, people who focus on Autism, people who focus on substance use, etc. If you’re bringing up an issue related to eating disorders for example, and your therapist says, “that’s not my area of expertise, but I can find you someone who is,” your therapist isn’t brushing you off. Your therapist likely wants to provide you with the best quality care possible, and doesn’t want to cause harm to you.
But what do you do if you don’t want a new therapist? Talk about it with your current therapist! Being referred out doesn’t mean that your relationship with the current therapist ends. It can mean you meet less frequently, or pause for some amount of time. We therapists don’t like those goodbye’s anymore than you do, and we don’t take referrals lightly.
Level of Care
There are several different, “levels of care” when it comes to the mental health world. Outpatient; your stereotypical, meet once a week in an office. Intensive Outpatient (IOP) or Partial-Hospitalization (PHP); increased level of care characterized by daily group therapy as well as individual therapy. Inpatient level of care is the highest level of care and involves staying overnight at a hospital, patients usually aren’t allowed to have shoe laces, sharp objects or their phones. In those settings, patients will get individual therapy, group and sometimes even family therapy, several times a week.
When you hear, “that’s not what this level of care is for,” especially at PHP/IOP or Inpatient, it usually means that there’s a lot to unpack with that topic, and to do so in this level of care, would require a lot more time, which insurance usually doesn’t like. Coming from a background of working in an adolescent inpatient setting, I was told several times not to go into trauma history with clients. By not getting into that trauma history, therapists and clients are able to keep things “nicely” packaged up, BUT are also unable to really get to the core root of a lot of behaviors.
When outpatient therapists say, “let’s talk about an increase in level of care,” that can sound really scary. It usually is accompanied by conversations around self harm or suicidal ideation. Not every therapist is comfortable with these topics, and will go to an increased level of care quickly. Others may not go fast enough.
What do I do with this information?
Talk to your therapist! If you’re unsure of what you could talk about, ask. Your therapist likely will help guide you through difficult topics, and if needed, could refer you to a specialist.
If you’re looking for a therapist to work on something specific like eating disorders, personality disorders, mood stabilization, look at their profiles! Lots of therapists have generic profiles, but look for what their specialities are and utilize their free consultation!
The Understory Group welcomes you to check out our clinicians, Nat Adey, LSW and Em Evans, LSW. Both clinicians are open for individual sessions. Nat runs a virtual group for young adults on Thursdays. Reach out for more info.